14D0431343 CLIA NUMBER - FIRST CHOICE HEALTHCARE HENRY COUNTY HEALTH DEPT

Laboratory Demographics

CLIA Number: 14D0431343

Facility Name: FIRST CHOICE HEALTHCARE HENRY COUNTY HEALTH DEPT

Facility Address:
110 N BURR BLVD
KEWANEE, IL
ZIP 61443
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Facility Phone Number: 309 852-5272

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1851394829

Taxonomy: 261QP0905X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0431343
LAB Type	Community Clinic
Facility Name	FIRST CHOICE HEALTHCARE HENRY COUNTY HEALTH DEPT
Street	110 N BURR BLVD
City	KEWANEE
State	IL
ZIP	61443
Phone	309 852-5272
CertificateType	3
CertificateEffectiveDate	8/3/2023
CertificateExpirationDate	8/2/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024